2 - Asthma

Question 1

What are normal breath sounds called?

Answer 1

vesicular

Question 2

Describe bronchial breath sounds

Answer 2

• tubular or hollow
• characteristic pause between inspiration/ expiration - occurs in bronchial tree

Question 3

What types of crackles are there?

Answer 3

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• Coarse - through lung secretions
• Fine - reopening of alveoli

Question 4

What is a Ronchial breath sounds?

Answer 4

a low pitched wheeze

Question 5

What is a Wheeze and what causes it?

Answer 5

• can be monophonic or polyphonic (COPD)
• caused by narrowing of the airways

Question 6

What is stridor?

Answer 6

• partial obstruction in the airway, usually upper
• MEDICAL EMERGENCY IN CHILDREN

Question 7

O SHIT ME

Answer 7

O xygen (94-98%)

S albutamol (5mg

H hydrocortisone (100mg IV) / prenisalone (40mg oral)

I patropium (0.5mg) (FEV < 75%)

T heophyline

M agnesium (1.2-2g IV)

E scalate

Question 8

What lines of treatment are for asthma?

Answer 8

1 - SABA

2 - steroid (beclemetasone)

3 - LABA

4 - increase inhaled steroids

5 - 4th drug

Question 9

What is good for aspirin induced asthma?

Answer 9

Montelukast - leukotriene receptor antagonist

Question 10

What does a FEV/FVC ration indicate?

Answer 10

>70% = restrictive

<70% = obstructive

Question 11

COPD vs Asthma

Answer 11

Asthma FEV can improve by 20% where as COPD is less likely

Question 12

What are the features of type1 respiratory failure?

Answer 12

• pO2 < 8
• PCO2 < 6.7 or normal
• ventilation perfusion mismatch: air O2 is less than blood O2 demands

Question 13

What are the feature of type 2 respiratory failure ?

Answer 13

• pO2 < 8
• PCO2 > 6.7 - decreased
• pH - inadequate ventilation and percussion building up

Question 14

What does SBAR stand for?

Answer 14

S ituation

B ackground

A ssessment

R ecommendation

Question 15

DR ABCDE of CXR interpretation

Answer 15

D etails

R IPE

A airway

B reathing

C ardiac

D iaphragm

E xtra

Question 16

D of CXR interpretation

Answer 16

Details

Name

DoB

AP or PA

supine or erect

Question 17

What does RIPE stand for in CXR interpretation?

Answer 17

Rotation - clavicle equdistance to the spine of the vertebrae Inspiration - 6-7 posterior ribs

Picture - clavicle, scapula and under the diapragm

Exposer - can the vertebrae be seen behind the mediastinum

Question 18

A of CXR interpretation

Answer 18

• trachea deviation?
• level of the carina

Question 19

B of CXR interpretation

Answer 19

consolidation

vesicular marking to the edge of lung

pleura - mesothelioma

Question 20

C of CXR interpretation

Answer 20

heart borders

cardiothoracic ratio (PA)

aortic knuckle

Question 21

D of CXR interpretation

Answer 21

air under diaphragm

costophrenic angle

cardiacphrenic angle

domes 1.5cm in height

Question 22

E of CXR interpretation

Answer 22

bone fracture

pacemakers

soft tissue

Question 23

Answer 23

Sarcoidosis

-bilateral hilar markings

Question 24

Loss of silhouette sign

Answer 24

• loss of costophrenic angle
• indicates pneumonia etc

Question 25

What is the ABCDE assesment?

Answer 25

Airway

Breathing

Circulation

Disability

Exposure and Everything Else

Question 26

How to asses Airway?

Answer 26

Responsive

Talking

Breath sounds: stridor, gurgling, snoring

Question 27

What intervention may need to be done Airway?

Answer 27

Open airway - tilt chin lift

Suction

Nebulisers - salbutamol

Nasopharingeal/ oropharyngeal/ igel

Question 28

How would you assess breathing?

Answer 28

RR

Sats

Breath sounds

Percussions

Question 29

What intervestigations would you do during breathing?

Answer 29

Sit up

O2

ABG

CXR

Question 30

What does Bat wings on CXR indicate

Answer 30

pulmonary oedema

Question 31

What does bibasal crepitations indicate?

Answer 31

pulmonary oedema

Question 32

How do you treat pulmonary oedema?

Answer 32

flurosemide

nitrate

if severe: use CPAP

Question 33

On examination of the lungs there is a global wheeze. What does this indicate?

Answer 33

Asthma

Question 34

On examination lung breath sounds are quiet and global, polyphonic wheeze. What does this indicate?

Answer 34

COPD

Question 35

On examination lungs sound quiet at bases and dull to precuss. CXR shows loss of costophrenic and cardiophrenic angles. What des this indicate?

Answer 35

Plural effusion

Question 36

How is a plueral effusion treated?

Answer 36

Treat cause

if not consider chest drain

Question 37

On examination precussion is hyper-resonant with decreased breath sounds with possible mediastinal shift. What does this indicate?

Answer 37

Tension pneumothorax

(also tracheal deviation but didn’t want to make it too easy)

Question 38

On examinaiton lungs have localised crackles with bronchial breath sounds. What does this indicate?

Answer 38

Pneumonia

(also raised temp, increased RR etc.)

Question 39

What questions to ask an asthmatic at thier annual review?

Answer 39

Have you had difficulty sleeping due to asthma?

Has your asthma interfeared with daily activities?

Have you had your asthma symptoms during the day?

Question 40

How to asses circulation?

Answer 40

HR

BP

Cap refill

Temp

Urine output

Question 41

What interventions may need to be done in circulation?

Answer 41

“Two wide bore canulas”

take bloods

Give fluid

Catherterise

Do ECG

“1 in, 1 out, 1 in ….”

Question 42

How to assess disability?

Answer 42

Dont ever forget glucose - BMs

AVPU or GCS

PEARL

Question 43

What interventions may need to be done in disablity?

Answer 43

IV dextrose

IM glucagon

Question 44

How is exposer/ everything else assessed?

Answer 44

Examination